BILLDESK MERCHANT APPLICATION FORM
MERCHANT DETAILS
1 Name of Merchant
2 Constitution of applicant
3 Address of Registered Office and
Corporate Office
4 Contact Details Name of Person
Landline
Mobile
E-mail
5 Website Address
6 Date of incorporation of company
7 Permanent Account Number (PAN)
9 Profile of Company / Main business
10 Description of products/services you
will be selling via the account
11 Names, Brief introduction of
Promoters / Director / CEO
12 Name of VC’s / Investors who have
invested into the company
13 Any other details that may be
relevant
SERVICE DETAILS
(Please tick the services that you require)
1 Credit Card Payment Gateways Visa - √
MasterCard - √
2 Debit Card Payment Gateways Visa - √
MasterCard - √
3 Net Banking Gateways √
4 Cash Card Payment Options
5 Do you want to offer EMI X
Payment Options to customers
SERVICE DETAILS
(Please tick the services that you require)
(available in respect of select
banks only)
6 Business Details Do you currently have any Yes but not working
other gateway
If Yes, name of Processor
Current Gateway Volumes
and Throughput details
Reasons for Shift of
gateway
7 Expected Business Throughput Expected Annual Sales
(total)
Expected Annual Sales
(through the gateway)
Average Ticket size of
transaction expected
8 Any other details that may be Revenue through PG will increase gradually.
relevant
